Arguments for a lower carbohydrate-higher fat diet in patients with a short small bowel

Medical Hypotheses
G P Bongaerts, René S V M Severijnen

Abstract

Short small bowel patients suffer from malabsorption due to a strongly reduced small bowel surface. These patients usually get a high caloric high carbohydrate-low fat diet at oral or enteral feeding. At several points our studies demonstrate that the effect of this formula is doubtful. In these patients the intestinal flora has strongly been changed and even become characteristic due to abundant presence of lactobacilli (up to nearly 100%). In many patients with a high carbohydrate-low fat diet these bacteria both produce massive amounts of d-lactic acid and gaseous CO2, and they destroy the primary bile acids that are necessary for uptake of lipids. Thus, they cause (i) an increased risk of D-lactic acidosis and D-lactic acid-associated encephalopathy, (ii) flatulence, abdominal pain and non-infectious diarrhoea, and (iii) low uptake of fat and lipophilic vitamins. It is argued that by gradually converting the diet to a low carbohydrate-high fat diet growth of the characteristic lactobacilli can be strongly reduced and so also the mentioned inconveniences.

References

Feb 1, 1990·Archives of Disease in Childhood·A J MayneI W Booth
May 1, 1997·Microbial Pathogenesis·G P BongaertsJ L Willems
Nov 21, 2000·Journal of Gastroenterology·G P BongaertsJ J Tolboom
May 1, 2001·Seminars in Pediatric Surgery·J A Vanderhoof, R J Young
Apr 13, 2005·Medical Hypotheses·Ger Bongaerts, René Severijnen

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Citations

Apr 29, 2014·Applied Physiology, Nutrition, and Metabolism = Physiologie Appliquée, Nutrition Et Métabolisme·Claude C RoyValérie Marchand
Dec 3, 2008·European Journal of Gastroenterology & Hepatology·Herbert Tilg
Aug 17, 2010·The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland·Claire L Donohoe, John V Reynolds
Dec 19, 2014·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Raphael C SunBrad W Warner
Jun 4, 2015·Arquivos De Gastroenterologia·Camila Bitu Moreno BragaSelma Freire de Carvalho da Cunha
Jun 22, 2018·Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition·Erika JohnsonLaura E Matarese

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